Illinois Central College
General Education Requirements
Substitution/ Waiver Form
DEPARTMENT USE ONLY
Received by: Department: Date received:
Student ID: Date:
Name:
(Print) Last First Middle Initial
Address:
Primary Phone:
E-Mail Address:
*Program of Study:
Statement of Request (be specific):
(If more space is required, use the reverse side of this form)
X
Student Signature
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Graduation Staff Recommendation/Comments:
Catalog of Record ______________________________________________________
X
Graduation Staff Signature Date
------------------------------------------------------------------------------------------------------------------
Statement of: Approval or Denial
X
Curriculum Manager Signature Date
Please return to the Graduation Office, L211.
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